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11.50 pm

The Minister of State, Department of Health (Mr. John Denham): I congratulate the hon. Member for Ruislip-Northwood (Mr. Wilkinson) on securing the debate. It gives the House an opportunity to discuss the existing disposition of some of the specialist services in west London, and the case for change that underpins the proposals for reorganisation that are currently the subject of public consultation. As the hon. Gentleman said, public consultation is about to close.

Although I shall inevitably need to rehearse some of the arguments lying behind the proposals that are currently out to consultation, it is important that I do not prejudge, or give any sense that I am prejudging, the consultation. Ministers will clearly need to approach the consultation, if and when it finally comes to us, with a fresh and open mind in regard to the issues that are raised. I hope the hon. Gentleman will forgive me if, for that reason, I do not engage in a detailed debate with him about some of his points. I think that would be wrong, given the present stage of the public consultation.

Mr. Gareth R. Thomas (Harrow, West): Does the Minister recognise that concern about the future of Harefield extends beyond the boundaries of the constituency of the hon. Member for Ruislip-Northwood (Mr. Wilkinson)? In particular, does he recognise that my constituents' concern relates particularly to access to cardiothoracic services, and will he ensure that that is taken into consideration in the final decision about the future of Harefield?

Mr. Denham: I recognise the broad spectrum represented by those who are concerned about the issue. I have received letters from my own constituents about the future of Harefield hospital, and there is a wide range of issues--including those relating to access and transport--that will have been reflected in the public

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consultation. If it is referred to Ministers, they will have to take careful account of those issues in the future. I acknowledge my hon. Friend's points, and his local concerns in particular.

The hon. Member for Ruislip-Northwood concentrated--as I think we all anticipated--on the future of Harefield hospital. It is one of the best-known heart and lung hospitals in the NHS, and I want to place on record the high regard in which we hold those services and the staff who provide them.

The hon. Gentleman has raised the future of Harefield hospital on many occasions on behalf of his constituents. I think we all know that, under the inspirational clinical leadership of Professor Sir Magdi Yacoub, Harefield hospital has been remarkably successful in its development of heart and lung services. It has also become a centre where research and development is an integral part of its work to improve life expectancy and the quality of life for those with serious cardiothoracic conditions.

Specialist care of the type that has been pioneered at Harefield is a crucial part of services that are provided for people with coronary heart disease. Services that begin with health promotion continue through primary care settings, with general practitioners and their staff assessing and diagnosing patients, referring them to cardiologists in the local acute hospital, As part of that pattern of service, emergency services are involved, including the highly trained paramedic ambulance crews who respond to the sudden and devastating coronary accident.

Many coronary heart disease patients are treated successfully without the need for referral to a specialist centre such as Harefield. Nevertheless, for those with particularly complex medical or surgical needs, the expertise available at Harefield and other centres of excellence can be the difference between life and death, and can give much improved quality of life and life expectancy.

No hospital is immune to pressures. Hospitals must modernise if they are to remain a vital and effective part of the larger entity that is the NHS. The willingness to embrace necessary change is key if we are to begin to build a modern NHS to meet the needs of patients both nationally and locally in west London. Harefield, along with the Royal Brompton, Hammersmith and St Mary's, is one of several centres in west London that provides specialist heart and lung services.

The hon. Gentleman is familiar with the background to the service reviews that have led to the public consultation by Kensington, Chelsea and Westminster health authority. The consultation has been on proposals for modernising specialist acute hospital services in west London. It has run for some four months from July until today. The fragmentation of specialist heart and lung, renal and specialist children's services has long been of concern to all those who wish to see continued improvement in clinical care and outcomes and in education, training and research.

The hon. Gentleman will know that, as part of the independent review of London's health services, the Government asked Sir Leslie Turnberg to assess the need

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for change in west London. He was also asked to look at the process that had been developed involving both the NHS and its academic partners in shaping the change.

Sir Leslie was encouraged by the progress that he saw. His report registered a particular concern that the way in which the service is currently organised in west London might not be maximising its long-term contribution to national and international research. He advised the Government to ensure that plans for a more rational distribution of specialist services throughout west London were achieved. The hon. Gentleman may recall that, unlike the previous Administration with regard to many of the reviews that they commissioned, this Government did not cherry-pick the expert independent advice that they received.

In the Government's response to Sir Leslie's report, we accepted all the recommendations that it made. In taking forward recommendations, the NHS Executive asked hospitals and health authorities in that area of west London, along with Imperial College, to take part in a review of specialist cardiac and thoracic services. That review commissioned expert clinical input from a panel chaired by Sir Terence English, an internationally respected figure in heart transplantation who completed the first successful heart transplant in the UK, and a past president of the Royal College of Surgeons. The review was completed in July 1998. It broadly confirmed Sir Leslie Turnberg's impression that cardiac and thoracic services in west London were not organised in a way that would continue to support the highest quality service and academic endeavour.

Sir Terence English advised that three out of the four cardiac centres in west London were not seeing a sufficient number of patients to support the highest quality of patient care or research and teaching. He recommended that existing services should be focused on fewer, larger centres. He also advised that co-location of specialist cardiac services with other related specialties would bring benefits not available to single specialty hospitals such as Harefield.

We have a number of specialist hospitals in the NHS that, through the immense talent and vision of a small number of specialists, have developed services of the highest quality and innovation. In certain instances, those hospitals find themselves with a relatively small number of patients. They can be geographically isolated from other hospitals and from other related specialties. There is growing evidence that suggests that clinical risk is best managed by ensuring that highly specialised services are undertaken in large, multi-disciplinary centres, where all appropriate support specialties are close at hand.

The hon. Gentleman is concerned about the possible future location of those services. I can assure him that the aim of the proposals--certainly, my aim in considering any proposals--will be to ensure that patients are winners in terms of being able to access services that are uniformly of the highest standard; and that staff are winners in terms of working in multi-disciplinary teams enjoying state of the art facilities and the best education and training opportunities. We aim to ensure that researchers are winners in terms of having the best opportunity to undertake programmes of excellence and innovation worthy of the 21st century.

The West London Partnership Forum, chaired by Lord Newton of Braintree, a Minister for Health under the previous Administration, was established to enable senior

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clinicians and managers in the NHS to discuss with colleagues in Imperial College how they should respond to the call within Sir Leslie Turnberg's review of London's health services for a more rational distribution of specialist care in London.

On 14 February 2000, the forum announced that its preferred option was for a new specialist heart and lung hospital alongside specialist children's services next to a rebuilt St Mary's hospital, as part of the Paddington basin scheme, which is London's biggest redevelopment. The forum's preferred option would also see the Hammersmith Hospitals NHS trust become the west London centre for specialist renal services.

As soon as the forum had a set of proposals, it laid them before the public in a consultation exercise. During the consultation period, the NHS has made available to the public large amounts of information to support the arguments in favour of the forum's preferred option and the other options considered. It has certainly been one of the biggest ever consultation exercises on proposals for change in the NHS, with 12 public meetings and large numbers of people attending each of them. There is an internet site with the consultation document available upon it. There will also be a further special public meeting, on 29 November, before the health authority considers the outcome of public consultation at its meeting on 13 December.

My understanding is that every effort has been made to ensure that those with an interest in the future of those services have had the opportunity to make their views heard. As I said at the beginning, I am unable to comment on the possible outcome of public consultation, as my position as Minister prevents me from doing so. However, our aim is to ensure that any change that flows from the process will be to the benefit of patients.

I do, however, understand that some people in the hon. Gentleman's constituency have strong feelings about the proposed changes. Harefield village quite clearly identifies with the hospital as an institution and sees it as part of the local community. The letters that I have received about Harefield express concerns about the proposed changes.

I should like to take this opportunity to mention various decisions that demonstrate our commitment to Harefield, both the hospital and the wider community. I should also like to remind the House that, regardless of the outcome of public consultation, capital investment is both justified and continues to be made in the fabric and services at Harefield hospital. A new patient services centre, for example, is being built at a capital cost of £4.2 million.

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We are also contributing £2.5 million towards phase 2 of the heart sciences centre, which is a research facility that was opened in 1992. The case has been made for further development of the facility, to provide new laboratories to facilitate research in the areas of gene therapy, chronic rejection, homograft valve research and tissue engineering. When he was Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), made a commitment to provide £2 million towards the project.

My right hon. Friend the Secretary of State for Health recently met Professor Sir Magdi Yacoub and, at that meeting, agreed to provide a further £500,000 towards phase 2 of the heart sciences centre. I think that that can be seen as reaffirming our commitment to support that centre.

The Secretary of State also heard more of current developments at Harefield and of the uncertainty that is inevitably felt at this time. Although there is no question of pre-empting the outcome of public consultation, he agreed to fund a feasibility study to explore the possible use of the Harefield site as a science park in the event that a decision is made to centralise clinical services elsewhere. I must emphasise that the feasibility study is being undertaken as a precautionary measure and in no way prejudges the outcome of the public consultation. I add that that study has been welcomed by health organisations in north-west London.

The common objective of all the Government's plans for the modernisation of the national health service is to ensure that the patient has equitable access to high-quality care and treatment. That is the objective of the NHS plan and of the national service framework for coronary heart disease. I believe that that is an objective shared by those who have been developing proposals for the re-organisation of specialist NHS cardiothoracic, renal and children's services in west London.

Whatever the outcome that follows from those proposals, the legacy of Harefield and its staff under the clinical leadership of Sir Magdi will be safeguarded for the benefit of tomorrow's patients. Harefield's contribution to the NHS is one that should be celebrated. I want to express my recognition and appreciation of that contribution--a contribution that will remain central to the success of clinical services, education and research for heart and lung disease and be recognised not only nationally, but all the way around the globe.

Question put and agreed to.

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